Bumrungrad Hospital Public Company Limited (BH) Earnings Call Transcript & Summary

[Foreign Language] Welcome to the analyst presentation for the third quarter and for the 9 months of 2024 Bumrungrad Hospital Public Company Limited. Thank you very much for listening in. My name is Achariya Sanrattana, Investor Relations and Sustainability. So for this time around, we are back to an online format for the analyst meeting, where we will have the prerecording of the analyst presentation posted on our website, IR page, and then will be followed by the live analyst meeting online for the Q&A sessions with management later. So we will hold the analyst presentation as an online format for the first and for the third quarter. Meanwhile, for the half year and for the full year result, we will hold the meeting as an in-person meeting. So in this way, we hope that it will be more convenient for our local analysts to join in online, but we'll still be able to meet face to face once in a while for the analyst meeting twice a year. Today's presenters are Khun Aniello Sorrentino, Corporate Chief Strategy Officer, who will talk about the key takeaway in the third quarter of 2024. Then we have Khun Artirat Charukitpipat, Chief Executive Officer. She will talk about the business update. And we have Khun Oraphan Buamuang, Chief Financial Officer. She will talk about the financial highlights and the financial performance in the third quarter and for the 9 months of 2024. Then we have Khun David Boucher, Chief Executive Officer, Bumrungrad International Hospital Phuket and Market, to give us an update on the Phuket project. Then we have Khun Rajeev Rajan, Chief Business Development Officer. He will give us an update on the business performance. And today, we also have Dr. Polakit Teekakirikul, Chief Executive Officer of the VitalLife Scientific Wellness Center and Esperance as well as the Chief Science Officer of Bumrungrad International Hospital, to give us a presentation on the VitalLife. So before we move on to the presentations by our executive, let me mention a little bit about our strong margins over the year and also an update on the CapEx plan for the next 5 years. So on this page, we show a graph of the EBITDA margin and also the net profit margin here in the last 5 years and also showing the current margins in the third quarter of this year. So as you can see in the graph, the upper line is the EBITDA margin, and the lower line is the net profit margin. So we continue to maintain a strong in both of the margins over the past year and also in the third quarter of this year. This is mainly due to the continuum of doing the cost management program that we have been doing, including the supply management to achieve the economy of scale and also to improve our operational efficiency over the year, and also that we maintain -- remain to commit to the prudent use of the OT and also the headcount management. On this slide here is an update on the CapEx plan that we usually update the CapEx plan for our investor community in the third quarter of every year. So on this page is the -- is an update for the year 2025 until the year 2029. So we show the total amount as well as the CapEx plan for -- by year of the commitment. So in this CapEx plan, it's covered both the new construction and the existing campus. For the new construction, it included the Soi 1 project that we are adding the building for the IPD building, which -- where we will be adding the 59 licensed beds in that one building. And then we will have another building for the Bumrungrad oncology, ICU and advanced technology. So for the next one in the new construction project is the BIH annex, where will it be a building for the women, children and the IVF center in order to unify the Center of Excellence there, and this building is expected to finish in the year 2026. Then for the BIH Phuket project, we announced the CapEx plan for THB 4.3 billion before. And for now, the total amount is still within the CapEx plan. The CapEx plan that we announced for to be used in the year 2024 has been spilled over to the year 2025 and some to 2026. For the existing campus, we have the -- we will have the relocations of the dental clinic from building B to the building C in order to increase its capacity and where the old location, it will be replaced by the Arabic check-up center. This is in order to increase the intensity and also to improve the IPD/OPD conversion rate of our Arabic patients. And for the renovations of the ICU and the CCU room, we will have some of the innovation in that as usual. For the renovations for the IPD room, we will continue to complete one floor a year until we complete the whole building of the 12 floor. So for this year, we completed the renovations of the floor 8. And for next year, we will begin the renovations for the floor 9. And we also include repair and replacement of the MEP system. This is for those buildings that the system has to be repaired or replaced. So the total of the CapEx plan for the next 5 years stood at THB 17.57 billion, which is slightly lower than our previous CapEx plan for the year 2024 to the year 2028 at THB 17.8 million. And lastly that I would like to mention is the Phetchaburi project hospital that we -- is a total of THB 10.18 billion. So as of now, we put it in the year 2029. And so for now, we don't have an immediate necessity to build this new hospital, but we keep this project in the project pipeline for now. So now I would like to pass on the presentation to Khun Neil Sorrentino.

[Foreign Language] and welcome to the Bumrungrad Hospital Public Company Limited's Q3 2024 Analyst Presentation. For the quarter, Q3 2024 for us was a soft and outlier performance quarter. Typically, Q3 for us is our strongest quarter. While our EPS was the same as the prior period, and year-to-date, our EPS was up 11.1%. For the quarter, we saw declines in areas where we've been seeing them for the balance of the year. It's specifically Myanmar, specifically Kuwait and an outlier country, Bangladesh, which had a 1-month shutdown. Rajeev Rajan, our Chief Business Development Officer, is going to talk about each one of these countries and specific to give you better insights as to what happened for the quarter. As I like to remark to the investor community, the things I'm concerned about and worry about are typically the things we cannot control. And in the quarter, we saw some negative geopolitical impact. We did see lower revenue intensity as a result of Middle Eastern patients, especially related to Kuwait, but there are other markets, UAE and others, where we just did not see the level of high revenue intensity we have seen in prior quarters, meaning Q1 and Q2. I will remark that for Kuwait, we have seen in Q4 a very, very, very subtle improvement in the Kuwait business. It's small, but we're hoping it's indicative of it growing into the future, where I was positively impressed by what is happening with the -- some of the Kuwait business in Q4. But as you look at the countries, U.S.A., China, Qatar were very, very strong for us in the quarter. Unfortunately, we could not -- with those strong countries, we could not cover the shortfalls in Kuwait. In Q1 and Q2, we were able to cover the shortfall in Kuwait. And that's principally because in the prior quarters, in the early quarters of 2023, the Qatar business was growing slowly. And then as the quarters progressed, it got much bigger and much bigger and much bigger. So the variance -- the negative -- positive variance in Q3, there wasn't that positive variance to cover that difference from Kuwait in particular because Q3 was such a big, big quarter for Qatar. And that's what you saw happening in Q1 and Q2. But Q3, there wasn't that positive delta variance, principally because Q3 2023 was so much bigger for Qatar than had been in the prior -- the earlier quarters. Myanmar did perform and has improved significantly by 10% in Q3 2024 but, from a quarter-to-quarter basis, was down, and we'll talk about what that issue is. It's the ongoing, noncontrollable question about the military instability in that country. And that has -- that continues, and it has not improved. We see very, very, very high ForEx changes. We see inflation pushing 200%. And we're seeing only a top tier of patients coming out of Myanmar into Thailand. We see many, many more Myanmar citizens coming here to buy properties, buy condos and move to Thailand because of the fears of retribution by the military. So looking at the quarter with respect to EBITDA, the margin was up 40.2% -- not up, but was 40.2% in Q3 2024 and, year-to-date, 40.5%. So we continue to perform on EBITDA margin at the 40% level, which tells me that while the revenue intensity for the quarter was lower than prior quarters, through good cost control, we've been able to maintain our margins. NOPAT, in the same way, 30.3% for the quarter and 30.4% through 9 months. I'll get back to the guidance question at the end of this presentation. Next slide, please. So when you look at the distribution of the revenues, it slightly changed in Q3 2024, down international nationality from 55% in Q3 2023 to 54% in Q3 2024, and the pickup was in Thai nationality. As I said earlier, you see the revenue changes being negative. That's a result of revenue intensity shortfalls, not necessarily volume. And looking at 9 months, pretty stable, 54% for international, 12% and 34% for all others. Next slide. Here is the countries by percentage of ups and downs for the quarter. Qatar continues to be our strongest Middle Eastern supporter from a patient standpoint, both inpatient, very, very high revenue intensity and outpatient. Myanmar, we've talked about. Cambodia, we'll discuss as well as Bangladesh during Rajeev's presentation. United States, and when you look at the United States, you will see that it's up, but it's not U.S. citizens coming from abroad. This is principally those United States citizens that are either in nearby countries or working in corporate settings in the Greater Bangkok area. China has been a pleasant -- not surprise, but a pleasant growth for 2024. Year-to-date, it's up significantly, and we're hoping to -- and we're looking at seeing China move almost up to THB 1 billion for the year. That's our projection for China, and that's from THB 200 million to THB 300 million in 2023. Oman down slightly, Mongolia up slightly, but that revenue base is small. And of course, Kuwait is the big one, 67.1%. To give you an update on what is happening with the whole development of the preferred provider network, they are making progress. It's slow progress, but they are making progress toward reestablishing. How it is, they're going to refer patients out of the country of Kuwait. As I said, we're seeing some trickle of patients coming, especially guarantee of payment patients. We are favored and privileged by the Kuwait embassy. So we're hoping that in time, this will get back to some level of support where it was before, which changes revenue intensity, which changes many, many things because our highest revenue intensity is from our international patients and, in particular, the Middle Eastern patients. Next slide. So going to the performance of the company year-to-date and quarter-over-quarter '23, you will see that the EBITDA and the EBITDA margin are presented here for you. In the quarter, the EBITDA in 2023 was THB 2.6 billion, slightly down 1.8% to THB 2.589 billion, but the margin was up from 38.9% up to 40.2%. On a year-to-date basis, the margin was up from 38% to 40.5%, and that's for the year, very strong. It tells me consistently that we're operating the organization effectively. On EBITDA for the year, we're up 8.5%. I mentioned earlier on EPS and NOPAT, we're up 11.1%, which we'll see here in a moment. Next slide, please. On net profit, you see that the margins are up slightly 28.8% to 30.3%, slightly up for the quarter on net profit. Typically, as I've mentioned earlier, our net profit growth in Q3 is typically higher than this on a percentage basis. And this is what I referred to earlier as it being an outlier quarter, principally for the issues that I talked about, which are in the main noncontrollable. For the year, 27.8%, up to 30.4% on margin. And for the year, we're up 11.1% on EPS. NOPAT, THB 5.2 billion, up to THB 5.8 billion. Next slide, please. Moving to our other principal entity. We have 18 entities total in the company, but this is our other principal entity, which I talk about quarterly, which is VitalLife. I won't go through the numbers with you, but VitalLife had a stunning quarter given the fact that we didn't have cross-reference referrals from a higher Middle Eastern-based centers to -- versus the lower Middle East-based centers. Some of this business is certainly international, but more and more of it is becoming domestically driven, meaning Thais and expats. And you can see the performance for the quarter was a very, very good quarter for us as you look at VitalLife's performance. Now going back to the first slide, on guidance for Q4, we're about halfway through Q4 and doing guidance, developing guidance, projecting guidance is always a slippery slope-related forecast. But as I look at it, given the Kuwait issue and some other issues we have talked about, and Rajeev will discuss this in detail, I expect the revenue for Q4 to be flat to minus 3%, better than where we were for Q3, which was 5%. I expect an improvement in that area from some of the other markets that are driving through beyond just Kuwait, beyond just UAE. Next week, we plan on having a live stream Q&A. I believe that's scheduled for next Wednesday. Is that correct? Next Wednesday at 10:00 a.m. Please join us for the live Q&A. I and management will be there to take all of your questions and answer whatever you may have on your mind about our company. Until then, thank you for your attention and listening. [Foreign Language]

[Foreign Language] Good morning, everyone. I'm Oraphan Buamuang, Chief Financial Officer. I'm pleased to report to you all the third quarter and 9-month 2024 financial performance and financial highlights. In terms of third quarter this year, total revenue decreased by 4.9%. EBITDA declined by 1.8%, and net profit flat when compared to the same period last year. The decline in revenue mainly came from the both Thai and non-Thai patient revenue decline. The EBITDA margin and net profit margin in this quarter were 40.2% and 30.3%, respectively. In 9-month 2024, total revenue increased by 1.8%. EBITDA and net profit increased by 8.5% and 11.1%, respectively, with EBITDA margin, 40.5% and net profit margin at 30.4%. I will walk you through more detail in the following slide. Total revenue. In terms of the total revenue in third quarter 2024 was THB 6,447 million, decreased from third quarter last year by 4.9%. Total revenue decline mainly came from decrease in revenue from hospital operations, which declined by 5% when compared to third quarter last year. The decrease came from non-Thai patient and Thai patient revenue decline by 6.8% and 1.4%, respectively. The decrease in non-Thai patient mainly came from Middle East segment and Indochina segment by 15.7% and 7.5%, respectively. For 9-month 2024, total revenue increased by 1.8%. This was mainly due to the increased revenue from Thai patient and non-Thai patient by 3% and 1.5%, respectively. In terms of revenue contribution by nationality, in this quarter, the contribution of Thai was 34% and international, 66%. The contribution between Thai and international was slightly changed from third quarter last year. This was mostly due to a decrease in Thai patient revenue at 1.4%, which is lower than a decrease in revenue from non-Thai patient at 6.8%. For 9 months 2024, the revenue contribution from Thai and non-Thai were 34% and 66%, respectively, which were the same as 9 months 2023. In terms of revenue contribution by service, in third quarter, this year, the revenue contribution from outpatient service increased to 50% from 49% in third quarter last year due to OPD revenue decrease by 1.9%, which is lower than IPD revenue decrease at 7%. For 9-month 2024, the revenue contribution from outpatients increased to 50% from 49% in 9-month 2023. This is due to the outpatient revenue growth at 4%, which is higher than inpatient revenue growth at 0.1%. In terms of revenue contribution by payer type, insurance contribution in 9 months 2024 increased to 19% from 18% in the same period last year due to insurance revenue for 9 months this year increased year-over-year by 6.5%. The government third-party contribution in 9 month 2024 remained at 18%. Self-pay contribution in this year slightly declined to 62% from 63% in the previous year, mostly due to revenue from self-pay patients increased by 1.5%, which is lower than revenue growth rate of insurance payer. In terms of EBITDA and EBITDA margin. EBITDA in third quarter this year was THB 2,589 million, declined from same period last year by 1.8%. This represents a favorable change compared to the 5% decline in revenue from hospital operation. EBITDA margin in this quarter was 40.2%. For 9 month 2024, EBITDA was THB 7,843 million, improved from same period last year by 8.5%, with EBITDA margin at 40.5%. This improvement came from the revenue increase plus the cost continued management program. In terms of net profit and net profit margin. Net profit in third quarter this year was THB 1,955 million, slightly increase from same period last year by 0.04%. This represents a favorable change compared to the 5% decline in revenue from hospital operation. The improvement mainly came from a higher interest income and lower corporate income tax from BOI investment. Net profit margin was 30.3%. For 9 months, 2024 net profit was THB 5,872 million, improved from same period last year by 11.1%, with net profit margin at 30.4%. In terms of leverage ratio, net debt to EBITDA of 9 months 2024 was negative at 0.3x due to less net debt. And net debt to EBITDA was also negative at 0.1x due to less net debt as well. In terms of liability to asset. In this quarter, the percent of liability to asset improved to 14.6% when compared to previous quarter and same period last year. This is due to the higher net asset in this year. In terms of cash flow statement, at the ending of 9-month 2024, total cash and investments increased to be almost THB 12 billion. This came from higher operating income in this year and cash correction from account receivable, especially Middle East account, offset with the dividend payment to the shareholders. In terms of increasing in long-term investment, we have invested in long-term corporate bond to capture the higher interest income yield in this year. These are all the financial highlights and financial performance of third quarter and 9 months 2024. Thank you for your attention.

[Foreign Language] I'm going to present our business update in Q3 this year. Let's start with the first slide. We are very pleased to announce that Bumrungrad Hospital won the Best Public Company of the Year in Health Sector organized by Money & Banking Magazine. Additionally, we have been recognized as one of the top 100 ESG companies by the Thaipat Institute for the second consecutive year. This recognition shows our commitment for dedication to environmental, sustainabilities and corporate governance. This is to show about performance of our Center of Excellence. Currently, we 8 (sic) [ 9 ] Center of Excellence. You can see from the numbers, colorectal surgery and spine still have significant growth. However, for high-intensity service such as cardiology, oncology and neurology declined for unexpected decrease in Middle East market, especially Kuwait. The last slide. In August, we celebrated the certification as genomic medicine provider by the Ministry of Public Health. This certification distinguished Bumrungrad as a leader in genomic medicine in Thailand, emphasizing our role in leveraging cutting-edge genetic technologies to enhance our patient care. Thank you. That's all for me.

[Foreign Language] My name is Rajeev Rajan. I'm the Chief Business Development Officer. Overall, YTD, we have seen a growth of 2% year-over-year. For international, we have seen a growth of close to 1.1% YTD year-over-year and 3% for the Thai segment and 3.3% for the expat segment. Quarter-over-quarter comparison overall, we are a deficit of 5% year-over-year. 7% for the international segment quarter-over-quarter for the year, 1.4% for the Thai segment and 5% for the expat segment. To break that down into further detail, overall, YTD for the -- for 9 months compared to last year, Middle East, we have a deficit of close to 3.9% when compared to last year and close to around 15.7% for the third quarter compared to last year. To break it down even further for better understanding for the Middle East markets. Qatar has continued the momentum, what we had specifically in Q1 and Q2. Third quarter as well, we saw a growth overly about close to 6%, specifically for Q3 over Q3 for Qatar. And YTD, approximately around 32% growth year-over-year. Kuwait is a market where we have been very closely focusing to win back specifically because of the challenges which we have mentioned in the couple of quarters also in the last quarters. We continue to have the same reconciliation initiatives that we undertake with the Ministry of Health of Kuwait. In terms of resumption of services, we do not have a specific tentative date yet. But overall, on the self-pay part, on the direct patients paid by out-of-pocket, we see the similar trend. But overall, when compared to last year, when we had the GOP from MOPH and MOD, the deficit versus last year for Kuwait alone is approximately around 67% for the quarter versus last quarter -- last year quarter and 66% versus last year, YTD, for 9 months. Moving on, UAE is a market also where we see that we have a deficit when compared to the last quarter -- Q3 of 2023 versus 2024, which is approximately around 37% and, overall, a deficit of 24% for 9 months. However, Q2 of this year versus Q3 of this year for UAE, we have a 14% growth, close to approximately THB 30 million in value for UAE. Overall, for UAE, we have seen that there has been some decentralization happening. Initially, they had planned to centralize the treatment abroad division under DOH, which further again, this year's -- early starting this year, we saw initiative coming up to decentralize it back again where independent bodies -- institutions again restart to send direct referrals to Thailand. Armed Forces has recently started its office in Thailand. So we expect that recalibration specifically to happen. And since we have direct relationships with some of those key institutionalized business, we have experienced that slowdown when compared to Q3 of this year versus Q3 of last year. And we expect that momentum to come back once the recalibration is done. The institutions -- Armed Forces office has recently started up back here in Bangkok. And once the office is set up, we expect those high-intensity referrals to come back. Overall, for the Middle East segment, it's also a situation where we are closely watching. Where we have limited control is the current geopolitical situation, which is very unpredictable with the ongoing political tensions between countries in that region. This is also a situation which we do not have control. But overall, from experience, compared to last quarter over this quarter, we have seen some slowdown, specifically for elective surgeries, where people have delayed or rescheduled appointments and postponed their travel specifically to an indefinite date. So we expect -- we are closely monitoring this situation as well. So based on this, we would be continuing to offer assistance to our patients to make their treatment and travel to Thailand more accessible and more convenient. We are looking to have more outreach and connects -- community connect programs to ensure that we are in touch with our patients, and we can ensure that they have the best continuity of care back home. Moving on to the Indochina segment. Specifically YTD, we have seen a deficit of close to 3.2%. And quarter-over-quarter for this year versus last year, we've seen close to 7.5% deficit. To further break it down, I would start with Bangladesh. So Bangladesh is a country where we have seen specifically double-digit growth for this year. But unfortunately, we could not carry that momentum in Q3 because of some political tensions back in Bangladesh, where -- which started early Q3 where the country had to go through a blackout. There was a major protest in the country. The sitting Prime Minister was exiled from the country where she had to move and leave the country and seek asylum in an international location. This definitely affected our business, specifically for Q3, early Q3, August and September, but we recovered from that instance. It was -- overall, for a month, 45 days, we had close to zero business, and we had patients from -- who were admitted with us from Bangladesh wanted to go back home. But overall, we -- the situation over there has stabilized now with the interim in charge where Nobel laureate, Mr. Yunus, has taken office, and it's an interim nonpolitical government in place. Overall, the political situations have stabilized. And we have -- we now experience and we now see that the patients are coming back. There is a lot of stability. But it broke our momentum specifically for Bangladesh for this year, where we had a healthy double-digit growth starting early this year. And only for Q3, specifically for Bangladesh, we had a close to 9% approximately, a drop in terms of revenue when compared to Q3 of this year versus last year. But overall, for Bangladesh, we continue to maintain a double-digit growth, specifically of approximately 14.7% when compared to year -- YTD revenue for the 9 months year-over-year. Myanmar, moving on to Myanmar. So Myanmar is a market specifically also we understand is going through a lot of sensitivity in terms of -- we saw that in Q1 where we had issues related to passports where patients were finding difficult to get hold of passports, to renew their passports for international travel. Then voluntary service for government -- in government positions became mandatory for youths, which again was causing a lot of stress, specifically tensions in the country. But in addition to that, the inflation was top of the roof. Overall, there was huge ForEx devaluation. The power of the local currency devalued a lot. We saw it up -- it go up to approximately close to around 190, 200 as well. And overall, we saw that continuous up and down throughout the year. So overall, for this YTD and year-over-year, we see that similar trend. The situation has not worsened or not -- has not improved a lot. So we continue to have that same continuity in terms of the revenue intensity. And we also have connected well with the market. We have our clinic back in Myanmar, which helps us facilitate and reach out to our customers better in terms of connectivity, in terms of reach, in terms of our doctors going there and being able to provide their services locally to ensure better continuity of care. And Myanmar is -- overall, for the quarter-over-quarter for this year versus last year, we've seen approximately 4.2% drop in terms of revenue, which is a deficit, and overall, for the year, approximately close to an 8.6% deficit versus last year. Moving on, Cambodia. Cambodia, we have -- this is a market where specifically in Q1 and Q2, we had seen some deficit and specifically due to a lot of factors. One of those factors being, again, the geopolitics where the sense of spending among Cambodian nationals specifically became very sensitive because of -- there's a lot of volatility around it. In addition to that, there was also a price war situation, specifically because of local -- a lot of other health care service providers in this region who could not reach out to Myanmar, which is a primary market to other competition as well. They focused on to Cambodia as a market, and we saw price war situation, which started early this year. That somehow continued. But for Q3, we had a specific improvement specifically from our performance versus the initial quarters but not as good as what we received for the last year. But overall, in terms of performance, we were -- we are approximately at 9.6% YTD deficit versus last year but approximately 14% deficit in terms of quarter 3 over the quarter 3 of last year because of our phenomenal performance for last year. But one of the point that I would make -- like to make for Cambodia is we had a change of strategy specifically for Q3 in terms of some of our programs, which we could make it accessible before they travel from Cambodia, and we connected well with the -- with our customers, and we can see a specific acceptance of that initiative. And we see it to stabilize, and moving forward, we expect it to stabilize further and narrow down the deficit that we have experienced so far for this year. Laos is a market specifically where we have seen double-digit growth, specifically for this year versus last year. And for the quarter, we have seen approximately a 15% growth in revenue versus the same quarter last year. Moving on to the others segment. Specifically, a few of the highlights for the countries for others would be U.S. U.S. is a market which has specifically performed well for us for this year, and it continues to do so for Q3. In Q3 of this year versus the Q3 of last year for U.S. international patients, specifically, we see a growth of close to 22.6%. Approximately in YTD, we see a double-digit growth, which is approximately 17%. The major reasons being we continued our connectivity. We ensured we reach out. Again, U.S. international, specifically are for patients who are U.S. nationals residing in the CLMV region primarily. We ensured we have better connectivity. We reach out to them better. We engage with government institutions. And we facilitated their travel for their elective and selective tertiary and quarternary care, so specialties, and we facilitated that. And we continue to do so. We continue to maintain the relationships with the government institutions. China is a market where we have seen specifically growth throughout the year. And Q3, we continue to carry the momentum, specifically for Q3 versus Q3 of last year, close to around 25% growth. And YTD, we have seen close to 24% growth. China continues to do well in the expat segment as well. The other countries specifically are Mongolia, Ethiopia and U.K., which continue to do well, specifically when compared to third quarter of this year versus last year, where we see a double-digit growth for these markets as well. Now moving on to the overall expat and the Thai segment. For the expat segment, we have seen a deficit of close to around 1.4% when compared to the third quarter of last year. Overall, we have seen a growth of close to 3% for the expat segment approximately and close to 3% growth for the Thai segment as well for YTD 9 months data versus last year. Overall, for the expat segment, first, I would like to bring an interesting fact, which is linked with Myanmar, so we have seen overall the expat population for Myanmar growing in Thailand, specifically due to these political unrest and volatility in back home. So we see a lot of migration happening from Myanmar to Thailand, specifically for the wealthy, for the rich, for the affordable class where we see investments of Myanmar nationals coming and buying properties here in Thailand, sending their kids to school in Thailand. So we also adapted to that shift. And we strengthened our team specifically for the expat segment for Myanmar. And specifically for Myanmar expat segment, this segment has grown by approximately 35% quarter 3 over quarter 3 of last year. And we see a huge response, specifically in terms of our engagement with the expat community from Myanmar in Thailand. And the numbers are increasing, specifically in terms of residents and migrants coming and residing and living in Thailand. The other countries, specifically where we continue our momentum, specifically for the Thai and expat segment, would be our corporates and also U.S., Japan and China. We had specifically done one-of-a-kind outreach activity where we connected with most of our Chinese expat community, close to around 300-plus families through a networking lunch gala, which we organized at a facility outside, and we invited over 300-plus families, Chinese families, and we were able to engage with the community and connect with the community and specifically make more awareness about the health care system and the types of specific surgeries and procedures available in Thailand. Overall, the Thai and expat segments specifically continue to follow the similar trends of Q1 and Q2, and we are very positive towards how it has turned out in terms of a few specific markets. So overall, that's the update for -- the business update from my end. Thank you. [Foreign Language]

[Foreign Language] and good morning, everybody. Thank you for your valuable time today. My name is David Boucher. And again, I serve as the CEO of Bumrungrad International Hospital, Phuket and the Phuket market. Today, I'll share with you some updated information about our greenfield projects, plural, in the Phuket region. As you might recall from last quarter, we have designed a 50,000-square-meter, 212-bed acute care facility. We will have a total of 8 operating theaters plus a state-of-the-art cardiac cath lab, 2 C-section theaters and separate endoscopy suites. After a year of hard work and focus, I am pleased to share that our Environmental Impact Assessment, or EIA, is complete and has been awarded in just 8 short months from submission. We are in the process of obtaining construction permits, and we expect to be moving around during the current month of November. Accordingly, we are actively in the process of engaging a number of various contractors. Of course, our exterior design is complete, and we are working diligently on interior layouts and finishes. We are working in a focused, measured manner and have many aspects of this major project on parallel tracks. We now expect to open the new facility in the second half of 2026. From our 2-year-old Phuket referral office in Phuket town, we continue to increase the number of patients that we facilitate to Bumrungrad here in Bangkok almost every single month. As I shared with you back in August, we fully intend to leverage existing referral relationships from many parts of the world as Bumrungrad, we expand our clinical capacity in Phuket. I'm also pleased to share that we significantly increased our CSR activities in Phuket over the past quarter and have now provided free community services to 15 of Phuket's 17 subdistricts, with, of course, the major thrust being in Mai Khao, where the hospital campus is being built. On several activities, we have partnered with other entities on the island. Also out of our referral office, we continue to provide home nursing services for Bumrungrad patients pre and post care. We are very pleased to share that on September 27, we opened our first greenfield VitalLife longevity center in the Cherngtalay community of Phuket. The VitalLife center is progressively ramping up services and fine-tuning our delivery. Our grand opening officially will be in Q1 of 2025. Finally, on the eve of earthworks and construction, we naturally turn our attention from property and plant to people and processes. I'm pleased to share that we have commitments for our Phuket campus with both the Chief Nursing Officer and Chief Financial Officer, both existing Bumrungrad leaders. We are in discussions with other potential leaders as well. Let me close today by sharing that we are both excited and confident about this THB 4 billion project in Phuket. Many good things are happening in Phuket. As you may have read recently in the Bangkok Post, Grade A residential projects are expected to grow 10% to 20% annually over the next 5 years, and we are having a bumper year for tourism, with 2024 visitors surpassing pre-COVID year 2019. But we are excited to begin construction as soon as we have all the necessary permits in hand. Thank you very much again for your time and attention. [Foreign Language]

Hello, everyone. My name is Dr. Polakit Teekakirikul. I'm the Chief Executive Officer of VitalLife Scientific Wellness Center and Chief Science Officer of Bumrungrad International Hospital Public Company Limited. Today, I'm very excited to share with you the story of VitalLife Scientific Wellness Center as your trusted partner for youthful longevity. Who we are. Our story began almost 24 years ago, and we're trying to integrate the wellness into the sick care. We are considered the first one in Southeast Asia to offer the wellness and antiaging. And later on in 2018, realizing the importance of wellness and integrated approach, we also opened and launched the integrated cancer center, so-called Esperance integrated cancer center, and that would be in 2018. For the past 20 to 24 years, we have been recognized by many awards. We are located in the main campus of Bumrungrad Hospital. We do have the wellness center in the newly opened Building D. We have 6 floors also with skin and aesthetic center on the 8th floor of Building C in the main campus. For Esperance integrated cancer center, we are located in 11th floor of Building C. As you can see here, we have been recognized by many awards. One of those is the best integrated health and wellness provider. And more recently, in 2024, we are also recognized as the most innovative corporate brand in wellness by Future Trends Ahead & Award, and that exemplifies how we are very serious about wellness, antiaging and, more recently, the longevity medicine. Let me tell you why we are serious about that. If you look at the preventive medicine in the past many years, we have transformed from the past medicine into the present medicine. Nowadays, people use evidence and clinical trials. But at VitalLife, we go beyond that. This is something called future medicine. We are talking about precision medicine, personalized medicine. We prevent the disease. Not only that, we prevent the risk factors. And ultimately, we try to promote the healthy longevity. If you look at the number here on this slide, the world's 60-plus population will double between 2000 and 2050. Thailand itself has gone into the aged population, and not a long time from now, we will go into super aged population. Many countries around the world follow suit. Some countries are in the aging population. To address this special need in terms of the population, we need to look at the fundamental factors. Here at VitalLife, we address the hallmarks of aging, and we do have 12 hallmarks here. Our organization stands at the forefront of longevity solutions. We address these hallmarks through, number one, innovative approach; number two, advanced interventions. We hope to optimize your health potential. Let me tell you a little bit about the concept here. Many people out there trying to address the health span, how long you live. But here at VitalLife, we address both lifespan and health span. Lifespan will stand for how well you live. On this figure, you can see that if you try to optimize the longevity as a result, you can increase both lifespan and also the health span by decreasing the period with the age-related disease. Here at VitalLife, the concept of illness and wellness is very crucial. At the left-hand side, you can see that Bumrungrad Hospital has focused and done very, very excellently on taking care of the disease and sick care. However, some people started to have the risk factor. They may not be sick. VitalLife works together with other subsidiary organizations, and Bumrungrad Hospital try to bring the people back to the left and all the way to the right-hand side gradually. So you can see that the scale from 0 will be all the way to the 10 with VitalLife approach. We are not very happy with just the comfort zone or the neutral health condition. But here, we aim for the high-level wellness with the optimal health condition. We cannot succeed with only VitalLife. We work together with internationally renowned professors and scientists around the world. I show you just some examples of all of these important people in our Scientific Advisory Board: Professor Evelyne Bischof, Dr. Claudio Viecelli, Professor Christopher Mason and Professor Brian Kennedy. All these international professors and researchers working together closely with our doctors and scientists to develop the program and shape your youthful longevity. Our key success will be through harnessing 20-plus years of sound expertise and technology breakthroughs. We gain insights from advanced biomarkers through cutting-edge diagnostics, and we provide proactive prevention through VitalLife's holistic longevity approach. Again, as I mentioned, our goal is to promote youthful longevity beyond just the health care. Here's just for example. We analyze, personalize, we optimize or even revitalize. Some of the examples that we propose and we offer, that will be the membership program. We can personalize 1-year plans to redefine the vitality and well-being holistically. Let me bring you to the new chapter of VitalLife. We have expanded our business and service to the wellness center in Phuket, where advanced health will meet the serene beauty of Andaman coast. In Phuket, all the service of VitalLife will be similar to what we offer in Bangkok. But more than that, you will see how we integrate all the nature, the beauty of Phuket together with the advanced technology offered through VitalLife Scientific Wellness Center. This is the number that will show you that we have had very good response. If you look at the VitalLife outpatient visits in the past few years, in post-COVID-19 pandemic era, we have observed the exponential growth of customers through the longevity approach. We also have many patients and health care seekers. If we break down by residences, you can see that we have from across all continents. We have worked very collectively and collaboratively, with almost 100 referral offices around the world. One of the key factor is to have professionals, for example, VitalLife physicians and all the scientists who can globally consult and give you all the services using the longevity approach in the pursuit of the youthful longevity care. Thank you so much. [Foreign Language]

So now we come to an end of the presentations. All analysts and fund manager, we hope to see you on our Q&A sessions live online on Wednesday of 13th of November at 10 a.m., so -- where our management will be happy to answer to all of your questions that you may have. For now, thank you very much for your attention and for listening in, and see you soon. Thank you very much. [Foreign Language]